Offset remote center manipulator for robotic surgery

ABSTRACT

Medical, surgical, and/or robotic devices and systems often including offset remote center parallelogram manipulator linkage assemblies which constrains a position of a surgical instrument during minimally invasive robotic surgery are disclosed. The improved remote center manipulator linkage assembly advantageously enhances the range of instrument motion while at the same time reduces the overall complexity, size, and physical weight of the robotic surgical system.

BACKGROUND OF THE INVENTION

The present invention is generally related to medical, surgical, and/orrobotic devices and systems. In an exemplary embodiment, the inventionprovides offset remote center manipulators which constrain a position ofa surgical instrument during minimally invasive robotic surgery.

Minimally invasive medical techniques are intended to reduce the amountof extraneous tissue which is damaged during diagnostic or surgicalprocedures, thereby reducing patient recovery time, discomfort, anddeleterious side effects. One effect of minimally invasive surgery, forexample, is reduced post-operative hospital recovery times. Because theaverage hospital stay for a standard surgery is typically significantlylonger than the average stay for an analogous minimally invasivesurgery, increased use of minimally invasive techniques could savemillions of dollars in hospital costs each year. While many of thesurgeries performed each year in the United States could potentially beperformed in a minimally invasive manner, only a portion of the currentsurgeries use these advantageous techniques due to limitations inminimally invasive surgical instruments and the additional surgicaltraining involved in mastering them.

Minimally invasive robotic surgical or telesurgical systems have beendeveloped to increase a surgeon's dexterity and avoid some of thelimitations on traditional minimally invasive techniques. Intelesurgery, the surgeon uses some form of remote control, e.g., aservomechanism or the like, to manipulate surgical instrument movements,rather than directly holding and moving the instruments by hand. Intelesurgery systems, the surgeon can be provided with an image of thesurgical site at the surgical workstation. While viewing a two or threedimensional image of the surgical site on a display, the surgeonperforms the surgical procedures on the patient by manipulating mastercontrol devices, which in turn control motion of the servomechanicallyoperated instruments.

The servomechanism used for telesurgery will often accept input from twomaster controllers (one for each of the surgeon's hands) and may includetwo or more robotic arms on each of which a surgical instrument ismounted. Operative communication between master controllers andassociated robotic arm and instrument assemblies is typically achievedthrough a control system. The control system typically includes at leastone processor which relays input commands from the master controllers tothe associated robotic arm and instrument assemblies and back from theinstrument and arm assemblies to the associated master controllers inthe case of, e.g., force feedback or the like. One example of a roboticsurgical system is the DA VINCI® system available from IntuitiveSurgical, Inc. of Mountain View, Calif.

A variety of structural arrangements can be used to support the surgicalinstrument at the surgical site during robotic surgery. The drivenlinkage or “slave” is often called a robotic surgical manipulator, andexemplary linkage arrangements for use as a robotic surgical manipulatorduring minimally invasive robotic surgery are described in U.S. Pat.Nos. 6,758,843; 6,246,200; and 5,800,423, the full disclosures of whichare incorporated herein by reference. These linkages often make use of aparallelogram arrangement to hold an instrument having a shaft. Such amanipulator structure can constrain movement of the instrument so thatthe instrument pivots about a center of spherical rotation positioned inspace along the length of the rigid shaft. By aligning this center ofrotation with the incision point to the internal surgical site (forexample, with a trocar or cannula at an abdominal wall duringlaparoscopic surgery), an end effector of the surgical instrument can bepositioned safely by moving the proximal end of the shaft using themanipulator linkage without imposing dangerous forces against theabdominal wall. Alternative manipulator structures are described, forexample, in U.S. Pat. Nos. 6,702,805; 6,676,669; 5,855,583; 5,808,665;5,445,166; and 5,184,601, the full disclosures of which are incorporatedherein by reference.

While the new telesurgical systems and device have proven highlyeffective and advantageous, still further improvements would bedesirable. In general, it would be desirable to provide improvedstructures and systems for performing minimally invasive roboticsurgery. More specifically, it would be beneficial to enhance theefficiency and ease of use of these systems. For example, it would beparticularly beneficial to improve the range of motion provided by therobotic surgical manipulator while at the same time reducing the overallcomplexity, size, and physical weight of the system.

BRIEF SUMMARY OF THE INVENTION

The present invention is generally related to medical, surgical, and/orrobotic devices and systems. In particular, the present invention isdirected to improved remote center manipulators used to support asurgical instrument and provide a center of spherical rotation, remotefrom any bearings or mechanical supports, at a desired location of theinstrument during minimally invasive robotic surgery. The remote centermanipulator constrains the instrument to move around a fixed center ofrotation, which is preferably coincident with an entry incision in apatient, such as the patient's abdominal wall. In an exemplaryembodiment, the invention provides an offset remote center parallelogrammanipulator linkage assembly which constrains a position of a surgicalinstrument during minimally invasive robotic surgery. The improvedremote center manipulator advantageously enhances the range ofinstrument motion along first and second axes while at the same timereduces the overall complexity, size, and physical weight of the roboticsurgical system. Such advantages in turn enhance the efficiency and easeof use of such robotic surgical systems.

In a first aspect of the present invention, a remote center manipulatorfor constraining a position of a surgical instrument is provided. Thesurgical instrument coupleable to an instrument holder during minimallyinvasive robotic surgery includes an elongate shaft. The shaft has adistal working end configured for insertion through an incision in abody wall into a body cavity of a patient. The remote center manipulatorcomprises an articulate linkage assembly having a mounting baserotationally coupled to a parallelogram linkage base for rotation abouta first axis. The parallelogram linkage base is coupled to theinstrument holder by a plurality of links and joints. The links andjoints define a parallelogram so as to constrain the elongate shaft ofthe instrument relative to a center of rotation when the instrument ismounted to the instrument holder and the shaft is moved in at least onedegree of freedom. The first axis and a first side of the parallelogramadjacent the parallelogram linkage base intersect the shaft at thecenter of rotation. Significantly, the first side of the parallelogramis angularly offset from the first axis.

The first side of the parallelogram is angularly offset from the firstaxis by at least 2 degrees, preferably by 10 degrees. Generally, thefirst side of the parallelogram is angularly offset from the first axisin a range from about 2 degrees to about 45 degrees, preferably in arange from about 2 degrees to about 35 degrees. The first side of theparallelogram may sometimes extend beneath the first axis, generally atleast one side of the parallelogram extends beneath the first axis. Themanipulator provides an improved range of shaft motion that is greaterthan ±90 degrees along the first axis, preferably greater than ±95degrees along the first axis. In particular, the cantileveredparallelogram linkage base provides shaft motion in a range from ±168degrees along the first axis, wherein the first axis is sometimesreferred to as a yaw axis. Advantageously, the offset articulate linkageassembly provides an improved range of shaft motion that is greater than±55 degrees along a second axis, preferably greater than ±60 degreesalong the second axis. Generally, the offset articulate linkage assemblyprovides improved shaft motion in a range from ±75 degrees along thesecond axis, wherein the second axis is sometimes referred to as a pitchaxis.

Preferably, at least one of the links is bent at an angle so as toprovide clearance for another link to rest on the bent link. Thisclearance prevents inter-linkage collisions so as to further allow foran improved range of pitch motion. For example, the link may be bent atan angle of about 22 degrees. The manipulator may not be balanced in atleast one degree of freedom. As such, a brake system may be coupled tothe articulate linkage assembly. The brake system releasably inhibitsarticulation of at least one of the joints. Preferably, the plurality oflinks and joints comprise at least one pulley and at least one flexibleelement coupled to the pulley that is configured to constrain shaftmotion relative to the center of rotation. In one embodiment, theplurality of links and joints comprise a linkage having six pulleys andfour belts. The plurality of links and joints are driven by aservomechanism. The plurality of links and the parallelogram linkagebase may be offset in different planes so as to reduce the possibilityof inter-linkage collisions. The plurality of links and the instrumentholder however may be located in the same plane.

In general, the articulate linkage assembly is configured to constrainshaft motion relative to the center of rotation. As such, the shaft ismaintained substantially aligned through the center of rotation as theshaft is pivotally moved in at least one degree of freedom. Preferably,the center of rotation is aligned with the incision point to theinternal surgical site, for example, with a trocar or cannula at anabdominal wall during laparoscopic surgery. As such, an end effector ofthe surgical instrument can be positioned safely by moving the proximalend of the shaft using the offset remote center robotic manipulatorwithout imposing dangerous forces against the abdominal wall.

In another aspect of the present invention, a remote center manipulatorfor constraining a position of a surgical instrument is provided. Thesurgical instrument coupleable to an instrument holder during minimallyinvasive robotic surgery includes an elongate shaft. The shaft has adistal working end configured for insertion through an incision in abody wall into a body cavity of a patient. The remote center manipulatorcomprises an articulate linkage assembly having a mounting baserotationally coupled to a parallelogram linkage base for rotation abouta first axis. The parallelogram linkage base is coupled to theinstrument holder by a plurality of links and pivots. The links andpivots define a parallelogram so as to constrain the elongate shaft ofthe instrument relative to a center of rotation when the instrument ismounted to the instrument holder and the shaft is moved along a plane ofthe parallelogram. Significantly, the first axis and a first pivot ofthe parallelogram adjacent the parallelogram linkage base are angularlyoffset and at least one of the links is bent.

The first pivot of the parallelogram is angularly offset from the firstaxis by at least 2 degrees, preferably by 10 degrees. Generally, thefirst pivot of the parallelogram is angularly offset from the first axisin a range from about 2 degrees to about 45 degrees, preferably in arange from about 2 degrees to about 35 degrees. The first pivot of theparallelogram may sometimes extend beneath the first axis, generally atleast one pivot of the parallelogram extends beneath the first axis. Themanipulator provides shaft motion in a range greater than ±90 degreesalong the first axis, preferably greater than ±95 degrees along thefirst axis. In particular, the cantilevered parallelogram linkage baseprovides improved shaft motion in a range from ±168 degrees along thefirst axis, e.g., yaw axis. Advantageously, the offset parallelogram andbent link together provide shaft motion in a range greater than ±55degrees along a second axis, preferably greater than ±60 degrees alongthe second axis. Typically, the offset parallelogram and bent linkprovide improved shaft motion in a range from ±75 degrees along thesecond axis, e.g., pitch axis.

At least one link is bent at an angle (e.g., 22 degrees) so as toprovide clearance for another link to rest on the bent link. At leastone of the links and pivots are not balanced in at least one degree offreedom. Accordingly, a brake system is coupled to the articulatelinkage assembly, the brake system releasably inhibiting articulation ofat least one of the pivots. Preferably, the plurality of links andpivots comprise at least one pulley and at least one flexible elementcoupled to the pulley that is configured to constrain shaft motionrelative to the center of rotation. In one embodiment, the plurality oflinks and pivots comprise a linkage having six pulleys and four belts.The plurality of links and the parallelogram linkage base may be offsetin different planes, while the plurality of links and the instrumentholder however may be located in the same plane.

In yet another aspect of the present invention, a remote centermanipulator for constraining a position of a surgical instrument isprovided. The surgical instrument coupleable to an instrument holderduring minimally invasive robotic surgery includes an elongate shaft.The shaft has a distal working end configured for insertion through anincision in a body wall into a body cavity of a patient. The remotecenter manipulator comprises an articulate linkage assembly having amounting base rotationally coupled to a parallelogram linkage base forrotation about a first axis. The parallelogram linkage base is coupledto the instrument holder by a plurality of links and pivots. The linksand pivots define a parallelogram so as to constrain the elongate shaftof the instrument relative to a center of rotation when the instrumentis mounted to the instrument holder and the shaft is moved along a planeof the parallelogram. The first axis and the parallelogram intersect theshaft at the center of rotation. Significantly, the parallelogram isangularly offset from the first axis. For example, a distal end of theparallelogram extending from a joint adjacent the instrument holder tothe center of rotation is angularly offset from the elongate shaft.

In still another aspect of the present invention, a remote centermanipulator for pivotal motion of a surgical instrument is provided. Thesurgical instrument coupleable to an instrument holder during minimallyinvasive robotic surgery includes an elongate shaft. The shaft has aproximal end and a distal working end configured for insertion throughan incision in a body wall into a body cavity of a patient. The remotecenter manipulator comprises a linkage base, a first linkage assembly,and a second linkage assembly. The first linkage assembly is pivotallysupported by the linkage base and has a first outer housing. The secondlinkage assembly is cantilevered between a proximal pivotal joint and adistal pivotal joint and defines a second linkage assembly axistherebetween. The proximal pivotal joint couples the second linkageassembly to the first linkage assembly. The distal pivotal joint couplesthe second linkage assembly to the instrument holder. The first andsecond linkage assemblies constrain lateral motion of the shaft topivotal motion about a center of rotation disposed along the shaft. Thesecond linkage has a second outer housing having a recess disposedbetween and separated from the first joint and the second joint so thatthe first outer housing of the first linkage assembly can protrude intothe recess and across the second linkage axis when the proximal end ofthe shaft moves toward the linkage base. The second linkage assembly maycomprise a flexible member in tension between the proximal pivotal jointand the distal pivotal joint, and at least one guide engaging theflexible member laterally so as to displace the flexible member awayfrom the recess.

In still another aspect of the present invention, a method forperforming minimally invasive robotic surgery within a body cavity of apatient employing a surgical instrument is provided. The surgicalinstrument coupleable to an instrument holder during minimally invasiverobotic surgery includes an elongate shaft. The shaft has a distalworking end configured for insertion through an incision in a body wallinto a body cavity of a patient. The method comprises providing anoffset articulate linkage assembly as described above. At least thedistal working end of the instrument shaft is introduced through theincision into the body cavity. At least the shaft of the instrument ispivotally moved in at least one degree of freedom while at least aportion of the distal working end is within the body cavity. The offsetarticulate linkage assembly constrains lateral motion of the shaft topivotal motion about the center of rotation so that the shaft ismaintained substantially aligned through the center of rotation.

A further understanding of the nature and advantages of the presentinvention will become apparent by reference to the remaining portions ofthe specification and drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The following drawings should be read with reference to the detaileddescription. Like numbers in different drawings refer to like elements.The drawings, which are not necessarily to scale, illustratively depictembodiments of the present invention and are not intended to limit thescope of the invention.

FIG. 1 is a schematic plane view of a portion of an operating theaterillustrating a robotic surgical system, including a master surgeonconsole or workstation for inputting a surgical procedure and a roboticpatient side cart for robotically moving surgical instruments havingsurgical end effectors at a surgical site.

FIG. 2 is a perspective view of the robotic patient side cart or stand,including two patient side robotic manipulators and one endoscope/camerarobotic manipulator.

FIGS. 3A and 3B are side and front views, respectively, of the linkageof the robotic manipulators of FIG. 2.

FIG. 4 is a perspective view of an articulated surgical instrument foruse in the system of FIG. 1.

FIGS. 5A and 5B are side and front views, respectively, of an exemplaryrobotic manipulator linkage assembly constructed in accordance with theprinciples of the present invention.

FIGS. 6A and 6B are additional side views of the exemplary roboticmanipulator linkage assembly.

FIGS. 7A and 7B are side views of the exemplary robotic manipulatorlinkage assembly illustrating an improved range of motion along a pitchaxis.

FIGS. 8A and 8B are side views of the exemplary robotic manipulatorlinkage assembly illustrating an improved range of motion along a pitchaxis.

FIGS. 9A through 9D are perspective view of the exemplary roboticassembly manipulator linkage illustrating an improved range of motionalong both the pitch and yaw axes.

DETAILED DESCRIPTION OF THE INVENTION

FIGS. 1 through 4 illustrate a robotic surgical system 1 for performingminimally invasive robotic surgery, which is described in more detail inU.S. Pat. No. 6,246,200. An operator O (generally a surgeon) performs aminimally invasive surgical procedure on patient P lying on operatingtable T, the operator O manipulating one or more input devices ormasters 2 at a surgeon's console 3. In response to the surgeon's inputs,a computer processor 4 of console 3 directs movement of endoscopicsurgical instruments or tools 5, effecting servo-mechanical movement ofthe instruments via a robotic patient-side system 6 (a cart-mountedsystem in this example).

Typically, patient side system or cart 6 includes at least three roboticmanipulator arms. Two arms or linkages 7 (mounted at the sides of cart 6in this example) support and position servo-manipulators 8 which drivesurgical tools 5; and one arm or linkage 9 (mounted at the center ofcart 6 in this example) supports and positions servo-manipulator 10which controls the motion of an endoscope/camera probe 11, whichcaptures an image (preferably stereoscopic) of the internal surgicalsite.

The image of the internal surgical site is shown to surgeon or operatorO by a stereoscopic display viewer 12 in surgeon's console 3, and issimultaneously shown to assistant A by an assistant's display 14.Assistant A assists in pre-positioning the manipulator 8 and 10 relativeto patient P using set-up linkage arms 7, 9, in swapping tools 5 in oneor more of surgical manipulator 8 (and/or 10) for alternative surgicaltools or instruments 5′, in operating related non-robotic medicalinstruments and equipment, and the like.

In general terms, the arms or linkages 7, 9 comprise a positioninglinkage or set-up arm portion of patient-side system 6, typicallyremaining in a fixed configuration while tissue is manipulated, and themanipulators 8, 10 comprise a driven portion which is activelyarticulated under the direction of surgeon's console 3. The activelydriven portion is herein generally referred to as a “manipulator”, andthe fixable portion of the positioning linkage of patient-side systemlinkage is referred to herein as a “set-up arm”, it being noted thatsuch set-up arms may optionally have powered and computer controlledjoints.

For convenience in terminology, a manipulator such as 8 actuating tissueaffecting surgical tools is generally referred to herein as a PSM(patient-side manipulator), and a manipulator such as 10 controlling animage capture or data acquisition device, such as endoscope 11, isgenerally referred to herein as a ECM (endoscope-camera manipulator), itbeing noted that such telesurgical robotic manipulators may optionallyactuate, maneuver and control a wide variety of instruments, tools anddevices useful in surgery.

FIG. 2 illustrates a perspective view of the cart mounted telesurgicalpatient-side system 6 of FIG. 1, including two PSM's 8 and one ECM 10.Cart system 6 includes a column 15 which in turn mounts threepositioning linkages or set-up arms, including two PSM set-up arms 7,each supporting one of the PSM's 8, and one ECM set-up arm 9 supportingECM 10. The PSM set-up arms 7 each have six degrees of freedom, and aremounted one on each side of centrally mounted ECM set-up arm 9. The ECMset-up arm 9 shown has less than six degrees of freedom, and ECM 10 maynot include all of the tool actuation drive system provided forarticulated surgical instruments, such as are typically included in PSM8. Each PSM 8 releasably mounts surgical tool 5 (shown in dashed lines)and ECM 10 releasably mounts endoscope probe 11 (shown in dashed lines).

FIGS. 3A and 3B are side and front views, respectively, of the linkageof the robotic surgical manipulator or PSM 8 of FIG. 2, having a remotecenter mechanism. PSM 8 is one prior art example of a manipulator whichmay be mounted and supported by a cart mount 6, ceiling mount, orfloor/pedestal mount. In this example, the PSM 8 preferably includes alinkage arrangement 20 that constrains movement of tool interfacehousing 21 and mounted instrument or tool 5. More specifically, linkage20 includes rigid links coupled together by rotational joints in aparallelogram arrangement so that housing 21 and tool 5 rotate around apoint in space 22, as more fully described in issued U.S. Pat. No.6,758,843.

The parallelogram arrangement of linkage 20 constrains rotation topivoting, as indicated by arrow 22 a in FIG. 3A, about an axis,sometimes called the pitch axis, which is perpendicular to the page inthat illustration and which passes through pivot point 22. The linkssupporting the parallelogram linkage are pivotally mounted to set-upjoints (7 in FIG. 2) so that tool 5 further rotates about an axis 22 b(FIG. 3B), sometimes called the yaw axis. The pitch and yaw axesintersect at the remote center 22, which is aligned along a shaft 23 oftool 5. Tool 5 has still further driven degrees of freedom as supportedby manipulator 8, including sliding motion of the tool along insertionaxis 22 c. Tool 5 includes proximal housing 24 which mounts tomanipulator interface housing 21. Interface housing 21 both provides formotion of the tool 5 along axis 22 c and serves to transfer actuatorinputs to tool 5 from the end effector actuator servo-mechanisms of PSM8. In this example of a remote center system, the parallelogramarrangement 20 is coupled to tool 5 so as to mechanically constrain thetool shaft 23 to rotation about pivot point 22 as the servomechanismactuates tool motion according to the surgeon's control inputs.

As tool 5 slides along axis 22 c relative to manipulator 8, remotecenter 22 remains fixed relative to mounting base 25 (mounting point toset-up arm 7) of manipulator 8. Hence, the entire manipulator 8 isgenerally moved to re-position remote center 22. Linkage 20 ofmanipulator 8 is driven by a series of motors 26 (FIG. 3A). These motorsactively move linkage 20 in response to commands from a processor (4 inFIG. 1). Motors 26 are further coupled to tool 5 so as to rotate thetool about axis 22 c, and may articulate a wrist (29 in FIG. 4) at thedistal end of the tool 5 about at least one, and often two, degrees offreedom. Additionally, motors 26 can be used to actuate an articulatableend effector of the tool for grasping tissues in the jaws of a forcepsor the like. Motors 26 may be coupled to at least some of the joints oftool 5 using cables, as more fully described in U.S. Pat. No. 5,792,135,the full disclosure of which is also incorporated herein by reference.As described in that reference, the manipulator 8 will often includeflexible members for transferring motion from the drive components tothe surgical tool 5. For endoscopic procedures, manipulator 8 will ofteninclude a cannula 27. Cannula 27, which may be releasably coupled tomanipulator 8, supports tool 5, preferably allowing the tool to rotateand move axially through the central bore of the cannula 27.

FIG. 4 illustrates an exploded perspective view of the articulatedsurgical tool or instrument 5 and proximal housing 24, that may beemployed in the system of FIG. 1. Tool 5 includes elongate shaft 23supporting end effector 28 relative to proximal housing 24. Proximalhousing 24 is adapted for releasably mounting and interfacing instrument5 to a manipulator (e.g., PSM 8 in FIGS. 1, 2, 3A, and 3B ), and fortransmitting drive signals and/or motion between the manipulator 8 andend effector 28. An articulated wrist mechanism 29 may provide twodegrees of freedom of motion between end effector 28 and shaft 23, andthe shaft 23 may be rotatable relative to proximal housing 24 so as toprovide the end effector 28 with three substantially orientationaldegrees of freedom within the patient's body.

Referring now to FIGS. 5A and 5B, side and front views are illustratedof an exemplary offset remote center robotic manipulator 30 constructedin accordance with the principles of the present invention. As describedin greater detail below, the refined manipulator 30 provides an offsetremote center parallelogram manipulator linkage assembly whichconstrains a position of a surgical instrument 32 coupled to aninstrument holder 34 during minimally invasive robotic surgery. Thesurgical instrument 32 includes an elongate shaft 36 having a distalworking end 38 configured for insertion through an incision in a bodywall into a body cavity of a patient. It will be appreciated that theabove depictions are for illustrative purposes only and do notnecessarily reflect the actual shape, size, or dimensions of the roboticsurgical manipulator 30. This applies to all depictions hereinafter.

Generally, the offset remote center robotic manipulator 30 is configuredto constrain shaft 36 motion relative to a center of rotation 66. Assuch, the shaft 36 is maintained substantially aligned through thecenter of rotation 66 as the shaft 36 is pivotally moved in at least onedegree of freedom. Preferably, the center of rotation 66 is aligned withthe incision point to the internal surgical site, for example, with atrocar or cannula at an abdominal wall during laparoscopic surgery. Assuch, an end effector of the surgical instrument 32 can be positionedsafely by moving the proximal end of the shaft 36 using the offsetremote center robotic manipulator 30 without imposing dangerous forcesagainst the abdominal wall.

Referring back to FIG. 5A, the refined remote center manipulatorgenerally includes an articulate linkage assembly 30 having a mountingbase 40, a parallelogram linkage base 42, and a plurality of links 44,46 and joints 48, 50, 52, 54. The term “joint” is used interchangeablywith the term “pivot” herein. The mounting base 40 is rotationallycoupled to the parallelogram linkage base 42 for rotation about a firstaxis 56, also known as the yaw axis, as indicated by arrow 58. Themounting base 40 allows for the surgical manipulator 30 to be mountedand supported by set-up arms/joints of a cart mount, ceiling mount,floor/pedestal mount, or other mounting surface. The mounting base 40 inthis embodiment is fixed to base support 60 by screws or bolts 62,wherein the base support 60 is adapted to be attached to the set-uparms/joints. The parallelogram linkage base 42 is coupled to theinstrument holder 34 by rigid links 44, 46 coupled together byrotational pivot joints 48, 50, 52, 54. The links 44, 46 and joints 48,50, 52, 54 define a parallelogram 64 so as to constrain the elongateshaft 36 of the instrument 32 relative to the center of rotation 66 whenthe instrument 32 is mounted to the instrument holder 34 and the shaft36 is moved along a plane of the parallelogram 64.

Significantly, the first axis 56 and the parallelogram 64 intersect theshaft 36 at the center of rotation 66, wherein the parallelogram 64 isangularly offset from the first axis 56. Specifically, a first side 68which originates from the first pivot 48 of the parallelogram 64adjacent the parallelogram linkage base 40 and the first axis 56intersect the shaft 36 at the center of rotation 66, wherein the firstside 68 and the first pivot 48 of the parallelogram 64 are angularlyoffset from the first axis 56. The first side 68 and first pivot 48 ofthe parallelogram 64 are offset from the first axis 56 by an angle α ofat least 2 degrees, preferably by 10 degrees. Generally, the first side68 and first pivot 48 of the parallelogram 64 are offset from the firstaxis 56 by angle a in a range from about 2 degrees to about 45 degrees,preferably in a range from about 2 degrees to about 35 degrees.

Referring now to FIGS. 6A and 6B, additional side views of the exemplaryrobotic manipulator linkage assembly 30 are illustrated showing theinstrument holder 34 in an extended position. The offset parallelogram64 arrangement allows for improved rotation of instrument 32 and holder34 over the prior art example described in FIGS. 3A and 3B while theremote center of rotation 66 remains at the same location. Specifically,as shown in FIGS. 7A, 7B, 8A, 8B, 9C and 9D, the offset articulatelinkage assembly 30 provides an improved range of shaft 36 motion thatis greater than ±55 degrees relative to a second axis (which isperpendicular to the page in these illustrations and which passesthrough pivot point 66), preferably greater than ±60 degrees relative tothe second axis. Generally, the offset articulate linkage assembly 30constrains shaft 36 motion about pivot point 66 in a range from ±75degrees relative to the second axis as indicated by arrow 72, whereinthe second axis is sometimes referred to as a pitch axis. Themanipulator 30 also provides an improved range of shaft 36 motion thatis greater than ±90 degrees relative to the first axis 56, preferablygreater than ±95 degrees relative to the first axis 56, as indicated byarrow 58 in FIGS. 9A and 9B. Typically, the cantilevered parallelogramlinkage base 42 constrains shaft 36 motion about pivot point 66 in arange from ±168 degrees relative to the first axis 56.

Additionally, similar to the discussed prior art, the yaw axis 56, thepitch axis (which is perpendicular to the page), and an insertion axis74 all intersect with each other at the remote center 66, which isaligned along a shaft 36 of the instrument 32. Thus, the instrument 32can be pivotally rotated though desired angles as indicated by arrows 58and 72 while the remote center of rotation 66 remains fixed in spacerelative to the mounting base 40 (mounting point to set-up arm) ofmanipulator 30. Hence, the entire manipulator 30 is generally moved tore-position the remote center 66. It will further be appreciated thatthe instrument 32 still has further driven degrees of freedom assupported by the offset remote center manipulator 30, including slidingmotion of the instrument along the insertion axis 74.

The new and improved offset articulate linkage assembly 30 whichdecouples the first pivot 48 and first side 68 of the parallelogram 64from the yaw axis 56 advantageously enhances the range of instrument 32motion about pivot point 66 relative to the second axis, as indicated byarrow 72. The manipulator 30 further allows for an enhanced range ofmotion relative to the first axis 56, as indicated by arrow 58. Animproved pivot range of motion along pitch and yaw axes in turn enhancesthe efficiency and ease of use of such robotic surgical systems. Forexample, the overall complexity of the robotic surgical system may bereduced due to the improved range of motion of the system. Specifically,the number of degrees of freedom in the set-up joints/arms may bereduced (e.g., less than six degrees of freedom). This allows for asimpler system platform requiring less pre-configuration of the set-upjoints. As such, normal operating room personnel may rapidly arrange andprepare the robotic system for surgery with little or no specializedtraining.

The plurality of links comprise an offset yaw link 42, a loweredvertical link 44, and a main bent link 46. The main link 46 is bent atan angle so as to provide clearance for the vertical link 44 to rest onthe main bent link 46. This clearance prevents inter-linkage collisionsbetween the vertical link 44 and the main bent link 46. For example, themain link 46 may be bent at an angle of about 22 degrees to allowclearance over a pitch dive 72 as shown in FIGS. 8A, 8B, and 9D. In suchan embodiment, the main bent link 46 and the vertical link 44 as well asthe instrument holder 34 are located in the same plane. It will beappreciated however that the main link 46 and the vertical link 44 mayalternatively be offset in different planes (i.e., placed side by side)to reduce inter-linkage collisions in lieu of bending main link 46. Thevertical link 44 pivot 48 is lower relative to the yaw axis 56 so as toprovide the offset parallelogram 64 arrangement, as discussed above. Theyaw link 42 is offset from links 44, 46, as best seen in FIGS. 9Bthrough 9D. Link 42 and links 44, 46 are not in the same plane, but arerather offset side by side so as to reduce the possibility ofinter-linkage collisions between link 42 and links 44, 46.

At least one of the rigid links 42, 44, 46 coupled together byrotational pivot joints 48, 50, 52, 54 are not completely balanced in atleast one degree of freedom. As such, a brake system may be coupled tothe articulate linkage assembly 30. The brake system releasably inhibitsarticulation of at least one of the joints 48, 50, 52, 54. It will beappreciated that the offset remote center manipulator 30 may comprise alighter system as the linkage is free of any counter-balancing weights.As such, the links 42, 44, 46 will preferably comprise sufficientlyrigid and stiff structures so as to support any vibration issuesassociated with the lighter manipulator 30. It will further beappreciated that the offset remote center manipulator 30 may optionallybe balanced by the use of weights, tension springs, gas springs, torsionsprings, compression springs, air or hydraulic cylinders, torque motors,or combinations thereof.

Referring back to FIGS. 6B, 7B, and 8B, the offset remote centermanipulator 30 may preferably comprise six pulleys 76, 78 a, 78 b, 80,82 a, 82 b and four flexible elements 84 a, 84 b, 86 a, 86 b coupled tothe pulleys 76, 78 a, 78 b, 80, 82 a, 82 b that are configured toconstrain shaft 36 motion relative to the center of rotation 66. Links42 and 46 are kept from rotating relative to each other by flexibleelements 84 a, 84 b running on two pulleys 76, 78 a, with one pulley 76fixed to link 42 and one pulley 78 a fixed to link 46. Links 44 and 34are likewise kept from rotating relative to each other by a flexibleelements 86 a, 86 b running on the remaining four pulleys 78 b, 80, 82a, 82 b, with one pulley 78b fixed to link 44, one pulley 80 fixed tolink 34, and idler pulleys 82 a, 82 b to get the flexible elements 86 a,86 b around the main bent link 46. Hence, links 42 and 46 can translatebut not rotate relative to each other to maintain the parallelogramshape 64. Likewise, links 44 and 34 can translate but not rotaterelative to each other to maintain the parallelogram shape 64. It willbe appreciated that the term pulley 76, 78 a, 78 b, 80, 82 a, 82 b caninclude wheels, gears, sprockets, and the like.

The flexible element 84 a, 84 b, 86 a, 86 b may include belts, chains,or cables connected around the pulleys 76, 78 a, 78 b, 80, 82 a, 82 b.Preferably, the flexible elements comprise multi-layer metal belts, suchas stainless steel belts having a breaking strength of approximately 800lbs and being about a quarter inch wide. The belts are preferablymulti-layered utilizing at least 3 plies, preferably 5 plies to bestrong enough to carry an adequate tension load yet sufficiently thinenough to not fatigue when repeatedly bent around the pulleys. Pulleys76 and 78 a have approximately the same diameter, e.g., 2.2 inches.Smaller pulleys 78 b and 80 have approximately the same diameter, e.g.,1.8 inches. There are two idler pulleys 82 a, 82 b at the bend of themain link 46 to facilitate running of belts 86 a, 86 b in oppositedirections so as to allow for attachment of the belts ends to be morerobust. Utilization of non-continuous offset belts 84 a, 84 b and 86 a,86 b provides for stress reduction, particularly at the attachmentpoints, thus minimizing failures. Further, non-continuous belts allowfor convenient tension and position adjustments. It will further beappreciated that belts 84 a, 84 b as well as belts 86 a, 86 b mayoptionally comprise continuous single belts. Additionally, the metalbelts may be lightly coupled to flat flex cables that carry electricalsignals along the manipulator arm.

The offset articulate linkage assembly 30 is driven by a series ofmotors. Motors may be located within the plurality of links to drive thepulley and belt mechanisms. Preferably, a majority of the motors arehoused in the lowered vertical link 44. In particular, the motor whichdrives the pitch axis 72 rotating link 44 relative to link 42 throughspur gears and a harmonic drive as well as the motors that runinstrument actuation cables (e.g., wrist drive cables which may bespring tensioned) may be housed in link 44. Placement of the verticallink 44, the main bent link 46, and the instrument holder 34 in the sameplane is advantageous as the motors that run the actuation cables arehoused in link 44. Further, having the vertical link 44, the main bentlink 46, and the instrument holder 34 in the same plane allows for spaceminimization at the distal end of the manipulator 30, which is ofsignificant importance when performing minimally invasive roboticsurgery in a confined operating environment. The motor driving the yawaxis 58 may be housed in mounting base 40.

Although certain exemplary embodiments and methods have been describedin some detail, for clarity of understanding and by way of example, itwill be apparent from the foregoing disclosure to those skilled in theart that variations, modifications, changes, and adaptations of suchembodiments and methods may be made without departing from the truespirit and scope of the invention. Therefore, the above descriptionshould not be taken as limiting the scope of the invention which isdefined by the appended claims.

1. A remote center manipulator for constraining a position of a surgicalinstrument coupled to an instrument holder during minimally invasiverobotic surgery, the surgical instrument including an elongate shaft,the shaft having a distal working end configured for insertion throughan incision in a body wall into a body cavity of a patient, the remotecenter manipulator comprising: an articulate linkage assembly having amounting base rotationally coupled to a parallelogram linkage base forrotation about a first axis, the parallelogram linkage base coupled tothe instrument holder by a plurality of links and joints, the links andjoints defining a parallelogram so as to constrain the elongate shaft ofthe instrument relative to a center of rotation when the instrument ismounted to the instrument holder and the shaft is moved in at least onedegree of freedom, wherein the first axis and a first side of theparallelogram adjacent the parallelogram linkage base intersect theshaft at the center of rotation, and the first side of the parallelogramis angularly offset from the first axis.
 2. The manipulator of claim 1,wherein the first axis and a second axis intersect at the center ofrotation.
 3. The manipulator of claim 2, wherein the first side of theparallelogram is angularly offset from the first axis by at least 2degrees.
 4. The manipulator of claim 2, wherein the first side of theparallelogram is angularly offset from the first axis in a range fromabout 2 degrees to about 45 degrees.
 5. The manipulator of claim 2,wherein the first side of the parallelogram is angularly offset from thefirst axis by 10 degrees.
 6. The manipulator of claim 2, wherein adistal end of the parallelogram extends from a joint adjacent theinstrument holder to the center of rotation, and wherein the distal endof the parallelogram is angularly offset from the elongate shaft.
 7. Themanipulator of claim 2, wherein the first side of the parallelogramextends beneath the first axis.
 8. The manipulator of claim 2, whereinthe manipulator provides shaft motion in a range greater than ±90degrees relative to the first axis.
 9. The manipulator of claim 2,wherein the manipulator provides shaft motion in a range between ±168degrees relative to the first axis.
 10. The manipulator of claim 2,wherein the offset articulate linkage assembly provides shaft motion ina range greater than ±55 degrees relative to the second axis.
 11. Themanipulator of claim 2, wherein the offset articulate linkage assemblyprovides shaft motion in a range between ±75 degrees relative to thesecond axis.
 12. The manipulator of claim 2, wherein at least one of thelinks is bent.
 13. The manipulator of claim 12, wherein at least one ofthe links is bent at an angle of about 22 degrees.
 14. The manipulatorof claim 2, wherein the manipulator is not balanced in at least onedegree of freedom.
 15. The manipulator of claim 14, further comprising abrake system coupled to the articulate linkage assembly, the brakesystem releasably inhibiting articulation of at least one of the joints.16. The manipulator of claim 2, wherein the plurality of links andjoints comprise at least one pulley and at least one flexible elementcoupled to the pulley that is configured to constrain shaft motionrelative to the center of rotation.
 17. The manipulator of claim 2,wherein the plurality of links and joints comprise a linkage having sixpulleys and four belts.
 18. The manipulator of claim 2, wherein theplurality of links and joints are driven by a servomechanism.
 19. Themanipulator of claim 2, wherein the plurality of links and theparallelogram linkage base are offset in different planes.
 20. Themanipulator of claim 2, wherein the plurality of links and theinstrument holder are located in the same plane.
 21. The manipulator ofclaim 2, wherein the articulate linkage assembly is configured toconstrain shaft motion relative to the center of rotation so that theshaft is maintained substantially aligned through the center of rotationas the shaft is pivotally moved in at least one degree of freedom.
 22. Aremote center manipulator for constraining a position of a surgicalinstrument coupled to an instrument holder during minimally invasiverobotic surgery, the surgical instrument including an elongate shaft,the shaft having a distal working end configured for insertion throughan incision in a body wall into a body cavity of a patient, the remotecenter manipulator comprising: an articulate linkage assembly having amounting base rotationally coupled to a parallelogram linkage base forrotation about a first axis, the parallelogram linkage base coupled tothe instrument holder by a plurality of links and pivots, the links andpivots defining a parallelogram so as to constrain the elongate shaft ofthe instrument relative to a center of rotation when the instrument ismounted to the instrument holder and the shaft is moved along a plane ofthe parallelogram, wherein the first axis and a first pivot of theparallelogram adjacent the parallelogram linkage base are angularlyoffset, and wherein at least one of the links is bent.
 23. Themanipulator of claim 22, wherein the first axis and a second axisintersect at the center of rotation.
 24. The manipulator of claim 23,wherein the first pivot of the parallelogram is angularly offset fromthe first axis by at least 2 degrees.
 25. The manipulator of claim 23,wherein the first pivot of the parallelogram is angularly offset fromthe first axis in a range from about 2 degrees to about 45 degrees. 26.The manipulator of claim 23, wherein the first pivot of theparallelogram is angularly offset from the first axis by 10 degrees. 27.The manipulator of claim 23, wherein a distal end of the parallelogramextends from a joint adjacent the instrument holder to the center ofrotation, and wherein the distal end of the parallelogram is angularlyoffset from the elongate shaft.
 28. The manipulator of claim 23, whereinthe first pivot of the parallelogram extends beneath the first axis. 29.The manipulator of claim 23, wherein the manipulator provides shaftmotion in a range greater than ±90 degrees relative to the first axis.30. The manipulator of claim 23, wherein the manipulator provides shaftmotion in a range between ±168 degrees relative to the first axis. 31.The manipulator of claim 23, wherein the offset parallelogram and bentlink provide shaft motion in a range greater than ±55 degrees relativeto the second axis.
 32. The manipulator of claim 23, wherein the offsetparallelogram and bent link provide shaft motion in a range between ±75degrees relative to the second axis.
 33. The manipulator of claim 23,wherein the at least one link is bent at an angle of about 22 degrees.34. The manipulator of claim 23, wherein the manipulator is not balancedin at least one degree of freedom.
 35. The manipulator of claim 34,further comprising a brake system coupled to the articulate linkageassembly, the brake system releasably inhibiting articulation of atleast one of the pivots.
 36. The manipulator of claim 23, wherein theplurality of links and pivots comprise at least one pulley and at leastone flexible element coupled to the pulley that is configured toconstrain shaft motion relative to the center of rotation.
 37. Themanipulator of claim 23, wherein the plurality of links and pivotscomprise a linkage having six pulleys and four belts.
 38. Themanipulator of claim 23, wherein the plurality of links and theparallelogram linkage base are offset in different planes.
 39. Themanipulator of claim 23, wherein the plurality of links and theinstrument holder are located in the same plane.
 40. A remote centermanipulator for constraining a position of a surgical instrument coupledto an instrument holder during minimally invasive robotic surgery, thesurgical instrument including an elongate shaft, the shaft having adistal working end configured for insertion through an incision in abody wall into a body cavity of a patient, the remote center manipulatorcomprising: an articulate linkage assembly having a mounting baserotationally coupled to a parallelogram linkage base for rotation abouta first axis, the parallelogram linkage base coupled to the instrumentholder by a plurality of links and pivots, the links and pivots defininga parallelogram so as to constrain the elongate shaft of the instrumentrelative to a center of rotation when the instrument is mounted to theinstrument holder and the shaft is moved along a plane of theparallelogram, wherein the first axis and the parallelogram intersectthe shaft at the center of rotation, and the parallelogram is angularlyoffset from the first axis.
 41. The manipulator of claim 40, wherein thefirst axis and a second axis intersect at the center of rotation. 42.The manipulator of claim 41, wherein the parallelogram is angularlyoffset from the first axis by at least 2 degrees.
 43. The manipulator ofclaim 41, wherein the parallelogram is angularly offset from the firstaxis in a range from about 2 degrees to about 45 degrees.
 44. Themanipulator of claim 41, wherein the parallelogram is angularly offsetfrom the first axis by 10 degrees.
 45. The manipulator of claim 41,wherein the first axis and a first side of the parallelogram adjacentthe parallelogram linkage base intersect the shaft at the center ofrotation, and the first side of the parallelogram is angularly offsetfrom the first axis
 46. The manipulator of claim 41, wherein the firstaxis and a first pivot of the parallelogram adjacent the parallelogramlinkage base intersect the shaft at the center of rotation, and thefirst pivot of the parallelogram is angularly offset from the firstaxis.
 47. The manipulator of claim 41, wherein a distal end of theparallelogram extends from a joint adjacent the instrument holder to thecenter of rotation, and wherein the distal end of the parallelogram isangularly offset from the elongate shaft.
 48. A remote centermanipulator for pivotal motion of a surgical instrument coupled to aninstrument holder during minimally invasive robotic surgery, thesurgical instrument including an elongate shaft, the shaft having aproximal end and a distal working end configured for insertion throughan incision in a body wall into a body cavity of a patient, the remotecenter manipulator comprising: a linkage base; a first linkage assemblypivotally supported by the linkage base, the first linkage assemblyhaving a first outer housing; and a second linkage assembly cantileveredbetween a proximal pivotal joint and a distal pivotal joint and defininga second linkage assembly axis therebetween, the proximal pivotal jointcoupling the second linkage assembly to the first linkage assembly, thedistal pivotal joint coupling the second linkage assembly to theinstrument holder, the first and second linkage assemblies constraininglateral motion of the shaft to pivotal motion about a center of rotationdisposed along the shaft, the second linkage having a second outerhousing, the second outer housing having a recess disposed between andseparated from the first joint and the second joint so that the firstouter housing of the first linkage assembly can protrude into the recessand across the second linkage axis when the proximal end of the shaftmoves toward the linkage base.
 49. The manipulator of claim 48, whereinthe second linkage assembly comprises a flexible member in tensionbetween the proximal pivotal joint and the distal pivotal joint, and atleast one guide engaging the flexible member laterally so as to displacethe flexible member away from the recess.
 50. A method for performingminimally invasive robotic surgery within a body cavity of a patientemploying a surgical instrument coupled to an instrument holder, theinstrument including an elongate shaft, the shaft having a distalworking end configured for insertion through an incision in a body wallinto the body cavity, the method comprising: providing an articulatelinkage assembly having a mounting base rotationally coupled to aparallelogram linkage base for rotation about a first axis, theparallelogram linkage base coupled to the instrument holder by aplurality of links and joints, the links and joints defining aparallelogram so as to constrain the elongate shaft of the instrumentrelative to a center of rotation when the instrument is mounted to theinstrument holder and the shaft is moved in at least one degree offreedom, wherein the first axis and a first side of the parallelogramadjacent the parallelogram linkage base intersect the shaft at thecenter of rotation, and the first side of the parallelogram is angularlyoffset from the first axis; coupling the instrument to the instrumentholder; introducing at least the distal working end of the instrumentshaft through the incision into the body cavity; and pivotally moving atleast the shaft of the instrument in at least one degree of freedomwhile at least a portion of the distal working end is within the bodycavity and while the offset articulate linkage assembly constrainslateral motion of the shaft to pivotal motion about the center ofrotation so that the shaft is maintained substantially aligned throughthe center of rotation.